The HPV Vaccine in the Jewish Community: The Confluence of Health and Halacha

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Abstract

Human Papilloma Virus (HPV) is reported to be responsible for nearly 90% of cervical
cancers, 90% of anal cancers and is a significant component of the etiology of vaginal, vulvar
and oral cancers as well. Added to the morbidity and mortality secondary to these cancers,
the virus causes precancerous cervical lesions and genital warts which in themselves cause
pain, discomfort and require medical care. However, unlike with most other cancers, there is
an approved vaccination against HPV, aimed at preventing the development of HPV related
conditions and cancers. When the vaccine was first approved in 2006, the Center for Disease
Control (CDC) published guidelines recommending that all girls receive the HPV vaccine,
ideally starting at age 13-15. However, since then, in spite of multiple public service
campaigns, the uptake remains low with rates of vaccination among female adolescents
remaining at only 42% as of 2015. As part of Healthy People 2020 initiative, the CDC aims
to have an 80% of all adolescents between the ages of 13-15 years old vaccinated by the year
2020. The barriers to increased vaccination acceptance are multidetermined and include
socio-cultural factors among parents, adolescents and physicians. Religious beliefs are
hypothesized to be one such element. This paper will outline the factors that impede vaccine
adoption and provide an analysis of these factors with a focus on the Jewish perspective
particularly in the American Orthodox community, along with potential suggestions for
improved vaccination penetration.
This paper will focus only on female vaccination, as although the CDC now recommends
that males be vaccinated as well, much of the research is based on parents vaccinating
specifically their daughters as a protection against cervical cancer. The form of the vaccine
referenced in most of the research can be assumed to be either the quadrivalent or bivalent
form, as the nonavalent form is still fairly new. Given that research comparing the three
versions of the vaccine has found equivalent, if not higher efficacy, between the
bivalent/quadrivalent and nonavalent forms, there is no reason to differentiate between
findings, especially as it relates to perspectives and health beliefs, from one version of the
vaccine to another form.